Bilateral Pulmonary Embolism Following a Viper Envenomation in France

Bart, Géraldine; Pineau, S.; Biron, Charlotte; Connault, J.; Artifoni, Mathieu

doi:10.1097/md.0000000000002798

Cited by 8 publications

(10 citation statements)

References 9 publications

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“…A nationwide French study [12] also did not reported serious hypocoagulation in patients after a V. berus bite. A case of pulmonary embolism in one V. berus bite patient has been reported by other French authors [18]. Such complications were not observed in either the current study nor the large study performed in France [12].…”

Section: Discussioncontrasting

confidence: 38%

Is coagulopathy a common consequence of a Vipera berus bite? A retrospective single centre study

Dyląg-Trojanowska¹,

Hodorowicz-Zaniewska

Zybaczynska

et al. 2018

Ann Agric Environ Med.

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Introduction. The Vipera berus (common viper) is the only species of venomous snake found in Poland. The aim of this study was to determine to what extent coagulopathy has occurred as a post-bite complication. Materials and method. The medical records of 138 adult patients in the Sucha Beskidzka hospital with the diagnosis of snake bite between 2001-2014 were retrospectively analyzed. Demographic, clinical and laboratory data were collected. Antivenom was given to all patients, except one, with snake bites, but laboratory test were taken prior to administration of antivenom. Obtained results were compared to those of the control group, composed of 176 adults hospitalized in the same period for an elective laparoscopic cholecystectomy. Results. The mean platelet count in the study group was 239.94×109/L (SD=56.56) and 248.77×109/L (SD=57.82) in the control group. In 98% of the study group and 100% of the control group the platelet value (PLT) fell within laboratory norms (130 to 420×109/L), 2 patients after snake bites had a PLT lower than normal, and thrombocytosis was not observed in either group. A reference range of 0.85-1.3 INR below normal was found in 2 patients in the study group and 15 from the control group, while values above the normal range were found in 8 patients (6.7%) from the snake bite group and no patients from the control group. In the study group, the INR ranged from 0.78-1.43 with a mean of 1.046 (SD=0.14), while in the control group the range was from 0.79-1.28, with a mean of 0.95 (SD=0.08). There was a significant difference in INR between the study and control groups (p<0.0001). Conclusions. The bite from V. berus does not result in severe thrombocytopenia, with only a moderate increase in INR values observed in about 7% of patients.

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Section: Discussioncontrasting

confidence: 38%

Is coagulopathy a common consequence of a Vipera berus bite? A retrospective single centre study

Dyląg-Trojanowska¹,

Hodorowicz-Zaniewska

Zybaczynska

et al. 2018

Ann Agric Environ Med.

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“…Despite its severity, few studies have examined pulmonary alterations in snakebite accidents [28, [52][53][54]. In crotalic accidents, crotoxin blocks the neuromuscular transmission that contributes to the development of paralysis, muscular respiratory insufficiency and acute respiratory distress [11,28].…”

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confidence: 99%

Evaluation of systemic inflammatory response and lung injury induced by Crotalus durissus cascavella venom

Azevêdo

Figueiredo

Pinto³

et al. 2020

PLoS ONE

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This study investigated the systemic inflammatory response and mechanism of pulmonary lesions induced by Crotalus durissus cascavella venom in murine in the state of Bahia. In order to investigate T helper Th1, Th2 and Th17 lymphocyte profiles, we measured interleukin (IL) -2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor (TNF) and interferon gamma (IFN-γ) levels in the peritoneal fluid and macerated lungs of mice and histopathological alterations at the specific time windows of 1h, 3h, 6h, 12h, 24h and 48h after inoculation with Crotalus durissus cascavella venom. The data demonstrated an increase of acute-phase cytokines (IL-6 and TNF) in the first hours after inoculation, with a subsequent increase in IL-10 and IL-4, suggesting immune response modulation for the Th2 profile. The histopathological analysis showed significant morphological alterations, compatible with acute pulmonary lesions, with polymorphonuclear leukocyte (PMN) infiltration, intra-alveolar edema, congestion, hemorrhage and atelectasis. These findings advance our understanding of the dynamics of envenomation and contribute to improve clinical management and antiophidic therapy for individuals exposed to venom.

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“…Considering that Europe has a relatively high number of Vipera species with relevant medical aspects, and that Europe shows the most favourable habitat, the underestimation is even greater, confirming the fact that snakebite in Europe is a disease with neglected incidence, morbidity and mortality. This is also justified by the fact that sporadic individual case reports and case series are found in the literature 4–81 …”

Section: Introductionmentioning

confidence: 99%

Vipera snakebite in Europe: a systematic review of a neglected disease

Paolino

Nicola²,

Pontara

et al. 2020

Acad Dermatol Venereol

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In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

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Bilateral Pulmonary Embolism Following a Viper Envenomation in France

Cited by 8 publications

References 9 publications

Is coagulopathy a common consequence of a Vipera berus bite? A retrospective single centre study

Is coagulopathy a common consequence of a Vipera berus bite? A retrospective single centre study

Evaluation of systemic inflammatory response and lung injury induced by Crotalus durissus cascavella venom

Vipera snakebite in Europe: a systematic review of a neglected disease

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